Most urinary tract infections (UTIs) are bacterial infections, and treatment is often with antibiotics. Nitrofurantoin (Macrobid) is often the first choice, but there are other options.

UTIs can affect the kidneys, the bladder, and the tubes that run between them.

They are among the most common outpatient infections in the United States, causing more than 8.1 million visits to healthcare professionals each year. They are more common in females. A UTI occurs when a person contracts a bacterial infection along the urinary tract, which includes the bladder, kidneys, ureters, and urethra.

Because a UTI is usually a bacterial infection, a doctor will typically prescribe antibiotics to treat it. However, the most suitable antibiotic will depend on the type of pathogen causing the UTI. Other treatments may help reduce symptoms.

In this article, we will discuss suitable medications for treating UTIs, as well as other treatments and remedies to help relieve symptoms.

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A UTI is an infection in any part of the urinary tract. The urinary tract is the body’s drainage system for removing urine. It consists of:

  • The kidneys: organs that filter waste from the blood and produce 1–2 quarts of urine per day
  • The ureters: the tubes connecting the kidneys to the bladder
  • The bladder: the organ that stores urine
  • The urethra: a tube at the bottom of the bladder that allows urine to exit the body

Most UTIs occur as a result of bacteria such as Escherichia coli (E. coli). However, other types of pathogens, such as viruses and fungi, can also cause UTIs.

A UTI may occur when a pathogen enters the urethra and infects any part of the urinary tract. The infection can irritate the lining of the urinary tract, leading to symptoms such as:

UTIs that affect the kidneys (pyelonephritis) may cause:

A UTI that affects the urethra is known as urethritis, and one that affects the bladder is known as cystitis. Health experts refer to UTIs affecting these parts of the urinary tract as lower UTIs, and they refer to infections of the kidneys or ureters as upper UTIs.

Doctors can classify UTIs as either simple or complicated. Simple UTIs typically affect only the bladder. Complicated UTIs are usually resistant infections that do not respond to traditional treatments and are more likely to result in potential complications.

Doctors may prescribe different antibiotics depending on whether the UTI is simple or complicated.

The type of antibiotic, the dose, and the length of treatment a doctor prescribes will depend on a person’s health status and the bacteria found in the urine culture. For example, treatment for complicated UTIs may take 7–14 days and require broad-spectrum intravenous antibiotics as well as hospitalization.

Most doctors can begin treating an uncomplicated UTI without any diagnostic test other than a urinalysis. They often order a urine culture for complicated UTIs or when initial treatment fails.

Doctors may prescribe the following first-line antibiotics for uncomplicated UTIs:

Nitrofurantoin (Macrobid)

This antibiotic is often the first line of treatment for lower UTIs because it concentrates in the lower urinary tract, maintains a low serum concentration, and has a minimal effect on the bowel flora. It kills the most common UTI-causing bacteria. It is a preferable treatment for UTIs because it has few adverse effects and a low potential for antibiotic resistance.

Trimethoprim-sulfamethoxazole (Bactrim)

This treatment is a combination of two antibiotics. Combining these two antibiotics helps make the treatment more effective, as they work synergistically. It is very affordable and is used to treat many illnesses, including middle ear infections, shigellosis, and pneumonia.

Fosfomycin (Monurol)

Fosfomycin is a potentially safe and valuable option for treating uncomplicated UTIs in females. However, a 2018 study suggests that nitrofurantoin may be more effective than Fosfomycin.

Second-line antibiotics are treatments a doctor may prescribe if first-line antibiotics are ineffective or stop working. A doctor may suggest second-line treatment if a person experiences recurrent UTIs or allergies or if the bacteria displays resistance patterns.

Second-line antibiotics may include:

Beta-lactam agents

Amoxicillin, cefdinir, cefpodoxime-proxetil, and cefaclor are in this group. These medications have lower clinical and bacterial cure rates than first-line antibiotics.

Fluoroquinolones

This group can include:

The Food and Drug Administration (FDA) strongly suggests that fluoroquinolones be reserved for use in people with no other treatment options. These drugs may cause severe side effects affecting the central nervous system, nerves, muscles, joints, and tendons.

Aside from antibiotics, doctors may recommend the following treatment options:

Antiviral or antifungal medications

If a person’s UTI is not the result of a bacterial infection, a doctor will not prescribe antibiotics. Instead, they will prescribe medications that are effective against the type of pathogen that is causing the infection.

For example, they will use antivirals to treat UTIs that occur as a result of viruses and antifungals to treat UTIs resulting from fungal infections.

Over-the-counter (OTC) pain relief medications

A doctor may suggest OTC medications to help relieve UTI symptoms. For example, a doctor may recommend phenazopyridine to help ease the discomfort, urgency, and frequency of urination when a person has a UTI. Acetaminophen may also help reduce pain and fever.

Click here to learn more about relieving UTI discomfort at night.

Plenty of water

Drinking a lot of fluids and urinating often can help speed healing by more quickly flushing out the bacteria from the urinary tract.

Heating pads

Applying heating pads to the abdomen or back can help manage bladder or kidney pain.

Cranberry juice

There is conflicting evidence on the benefits of cranberry juice in treating UTIs. However, it may help prevent a person susceptible to UTIs from developing them.

Vaginal estrogen

A 2021 study notes that prescribed vaginal estrogen may prevent UTIs in postmenopausal women with an active diagnosis of recurrent UTIs.

D-mannose

A 2020 systematic review and meta-analysis found that D-mannose, a type of sugar, could provide protection from recurrent UTIs with similar effectiveness to antibiotics. A 2016 study suggests that it can effectively aid in managing acute cystitis.

Herbal products and dietary supplements

Research has not confirmed the effectiveness of herbal remedies for UTIs, and the FDA does not regulate herbal remedies. However, a 2021 study suggests that herbal medicines could be effective at the first sign of infection and help prevent the infection from spreading in the short term.

People should always check with their doctor before using OTC herbal and dietary supplements.

Click here to learn more about home remedies for UTIs.

Below are the answers to some frequently asked questions about medication for UTIs.

Can a person get rid of a UTI without antibiotics?

In some cases, the body can resolve mild, uncomplicated UTIs without antibiotics. Research suggests that 25–42% of uncomplicated UTIs resolve without medical treatment.

However, not receiving treatment for a UTI does have some risks. As such, older adults, pregnant people, and those with underlying conditions should not try to treat their UTIs without antibiotics.

Will amoxicillin treat a UTI?

Amoxicillin is an antibiotic that doctors commonly prescribe to treat a range of bacterial infections. As such, a doctor may consider prescribing it to treat a UTI. They may use it as a second-line treatment option for UTIs.

How long does a UTI last without antibiotics?

The duration of a UTI will vary from person to person. It is possible for an untreated UTI to clear up in roughly 1 week. However, with treatment, a simple UTI is likely to resolve within days.

The best medication for a UTI depends on factors such as symptom severity, health status, medical history, and the pathogen causing the UTI.

Because bacteria are the cause of most UTIs, a doctor will most likely prescribe antibiotics. In such cases, a person should take the drug as the doctor prescribes and should finish the full course of medication even if they begin to feel better.

Stopping abruptly may prevent the drug from killing all the bacteria in the urinary tract or may cause these bacteria to become resistant to the drugs.